Attitudes in Mental Health Services

What jumps out at me about the recent report by PNA (Psychiatric Nurses Association) to the Minister of Health is that it underlines a definite antagonism between providers and patients in the mental health services. It conveys graphically and in a rather stock way a strong underlying sense of fear and loathing of mental patients. Undoubtedly relations between patients and nurses can assume knife-edge proportions at times. And it is, as we all know from human experience, at times of heightened tension or drama that basic and fundamental motivation emerges clearly in the spotlight. I believe Mr. Kavanagh (general secretary of PNA) when he says nurses in their hundreds have been injured by patients. I am sure he, too, can remember the names of John Carthy and Anthony Burke.

Well any report worth its salt should try to figure out why things are the way they are. What is the cause of the problem?

Respectfully I suggest that these reasons may be genuine but they are not central to the real cause of the problem.

Speaking of a patient who broke his way into the roof space the article again quotes the report

"When nurses got him down he was threatening and assaultative."

He was a "him" and he was "threatening and assaultative." Questions suggest themselves to me. Are these remarks a fair representation of the patient? Does this patient count as a human being? Why did he break into the roof space in the first place? A one word answer, "mental illness," would, in my estimation, be a total cop-out. It begs too many fundamental questions.

Well the PNA thinks that mental health services are in "free-fall." If the system broke down completely many highly paid jobs would be at stake. But to be brutally honest about it not many patients or prospective patients would shed a tear for what is an unlovely system as it now stands

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Comments (25 of 25)

My own scope on the subject is that we need to rethink our definition of mental illness.
Most of those classified as such are more a danger to themselves than to the general public.
Time and time again we are reminded that true insanity can wear an Armani suit, a military uniform decorated with medallions, or a priest's vestments and be protected by our culture of dont disturb the powerful, knowing, as we all do, the forces they can mobilise to protect themselves.
Those designated as mentally ill are often no more than the casualties of a sick, and deteriorating social environment maintained by polished lunatics whose logic of rationality is that of the roulette wheel and the hi-tech knuckleduster.Their answer to the symptoms of their asocial mindset is to hose it down with valium or prozac. The problem is that, for all the conscientious workers in the field of psychiatry, no admission of the insanity of the behaviour of the 'pillars of society' must be mooted. We comlacently comply with a system that begs over our airwaves for relief for the millions in Haiti and Pakistan, shortly after it has arbitrarily decreed that the poorest will pay for several generations for the crimes of its richest. A professional golfer can 'earn' a million for taking a stroll, while everywhere miners risk their necks for a pittance and our hospitals are scrubbed by contract workers on minimum wage, if lucky.
Not my form of sanity, so certify me.

Hi Opus. I think you are hitting the nail on the head. Mental patients are often people who do not "fit in" in school, in their families, at work. The paradox of all this is that most of our systems and institutions are manifestly dysfunctional i.e. it's a crazy world. However, thankfully, mental patients are victims and are in no way responsible for the current social, political, world order. You could make the case that the community is robbed to some extent of an alternative point of view on account of the suppression of mental patients who, often, have a fresh, clear and original way of looking at things.

Lest we forget the mental torture used to inflict unmerciful pain / anguish on a parish secretary , see indymedia archives in relation to 'The Parish Secretary '
and The Parish Priest , Reverend Blue Jeans himself , Father Laurence White, ;

Unfair Dismissal Of Parish Secretary is the title , the scheming tactics used against the lady
by her employer would make a pussy cat vomit .

Very Reverend (sic) Fadder Laurence White for his sins has now been 'elevated' to head
honcho to the homeless of Bray Co. Wicklow , thats the wages of sin one can expect as a
result of applying mental torture upon a lady who merely reported a member of the church ground Fas Brigade , to the very reverend himself , for having access to porn on a computer
which was in operation within the perimitor of Our Lady Queen of Peace Church , Putland
Road , Bray County Wicklow .

Corruption never takes as much as an afternoon nap in some places , in this particular
place of warship corruption is suffering from insomnia .

Thanks for your comment, Sceptic. Yes, a case in point. I remember reading about the parish secretary at the time although I never kept track of all the ins and outs of the particular case. Generally, in the past, where the psychiatrist was consulted he generally came down in favour of the "heavy" side of the argument. The cause of a lot of anguish, I agree. But in my limited experience things are changing even if only slightly. The psychiatrist these days is apt to take a more intelligent approach and delve beneath the surface to understand the real dynamics of a particular situation.

My Uncle Jack used to advise me (and I was always game for a fight when I was young),

"He who fights and runs away lives to fight another day."

It is no disgrace to lose a battle. It is more important if you are going to fight to fight on the right side - and that is not always the winning side! Sometimes a full-blown dispute is useful to the loser because it gets him or her out of an unhealthy and abusive situation.

Dr Mohan has his thumb on every involuntarily detained patient in Ireland. He is so powerful no other practicing psychiatrist in Ireland will disagree with him. For those detained, he is judge, jury and jailer. Once he has made his judgement there is no appeal in any tribunal our court.

No single man should have such a degree of incontestable power over the lives of others. And the fact that his expert opinion is up for sale makes that fact even more unsettling.

Margaret O'Hehir ( P.S.) put up such a fight the likes i have never witnessed , i kid you not .

The Parish Priest set her up and had margaret 'diagnosed' by a psychiatrist buddy known
as Dr Mohan , he susequently reported that margaret was 'suffering from Erotimania' , this
'diagnosis' was frought with holes bigger than potholes in Cavan , she hired a solicitor and
barrister at a cost of 26k to clear her name , she went to employment tribunerals in order
she should be re-instated in her job as parish secretary, to no avail ,

Margaret eventually went to Wicklow Circuit Court and both she and 'Fadder' Larry were
advised to 'make up' as one can imagine , to cut to the chase an advertisement was placed
in the personal column of The Oirish Times ( 900 Euros ) which exhonarated both .

'Fadder' Larry still bible thumps his way around The Queen of Peace Church whilst Dear
Margaret has moved on to pastures new down the country and is quite happy as far as i
know today , she and i are Bray People & i kind of knew her when i went to school as a
snotty nosed little gurrier with the arse hanging out of me short corduroy suspender held
shorts ( no longers allowed ) which was the norm for knobbly kneed little brats such as i in
the 60s , she commutes to and fro and still retains her home in Bray today , while i languish
in a nice area of Dublin 4 , ( for my sins) ;

Thank you for your interest and i hope this little update is to your satisfaction .

an tSionnainn's comment seems to confirm the need for re-definition. Especially when you consider the use of accusations from the bench such as for awkward customers like Maura Harrington above in Shellmullet. Ken Kesey made the point with his classic Cuckoo's Nest.The commited were the ordinary fuck-ups like ourselves.The real dangerous menace was Nurse Ratchet, control freak and puritan bigot par-exellence.
Ego is the current yardstick of mental salubrity.The tougher the shell(that just fell out there, but the pun fits, so I'll let it sit) the more is mental health judged robust, even though you could be diagnosing Pinochet or Marcos.Or Rumsfelt or Cheyney.Or Micky McDowell, smiling deporter of native born Irish children and sweetheart of our press where increasingly the only trace of health or honesty is to be found in the cartoons.
The herd is sane, the maverick the danger.Not that I dont recognise the clinical casualties, but the understanding of mental health is deficient, populist, and open to abuse. Blind religious faith I see as one of the most unhealthy manifestations of psychological immaturity.A deliberate REFUSAL to receptively listen, consider, adapt and grow. Self-induced(with the assistance of that renowned jesuitical indoctrination till 7)mental retardation.Coleridge's 'death in life'.

Thanks to An tSionann for information which as far as I can remember is news to me. Really I don't want to second guess Dr. Damien Mohan or to tell him how to do his job. But I thought that new legislation introduced a Mental Health Commission and Mental Health Tribunals in order to remedy the old feudal element in psychiatry that seems to be central to your point. Or is The Central Mental Hospital in Dundrum outside the remit and oversight of these new authorities? And I am happy to learn from Sceptic that the parish secretary is alive and well. I must confess that I never read One Flew Over the Cuckoo's Nest nor did I see the film and I probably never will now. Most of what I think is based on what I have seen for myself. But I think Opus Diablos is a well versed young man and he is not afraid to make his case. However there seems to be a high degree of consensus in the present discussion. That in itself can be a danger signal. We could all be on treacherous ground.

..is your safest footing.Ta for the 'young man'. Howdya know i'm not an ould hag?
It's never too late to track down the 'Cuckoo's Nest'. Film or book.
failing that, find a copy of Sylvia Plath's or Francis Farmer's history for an intro.

.......Failing that info , should one go to Bray where the cross on Bray Head was erected
circa 1951/ 2 in rememberence of lost sailors who drowned off shore , & scale same as i
often done as a nipper ( corduroy shorts inc ) one can actually see Snowdonia Mountains
in wales , cloudy weather no-see , downwards one can spot The Chapel on The Hill where
one may visit to see a live show of 'One Flew over the Cuckoo's Nest ' . i'm pretty certain
it goe's live, 24/7.... i do not visit Bray that often these days as Bride of Alucard may still
await my shadow perhaps in The Martello , sights set and ready when you are ol' smith &
weston : + )

But I thought that new legislation introduced a Mental Health Commission and Mental Health Tribunals in order to remedy the old feudal element in psychiatry that seems to be central to your point. Or is The Central Mental Hospital in Dundrum outside the remit and oversight of these new authorities?

There is a separate system for mentally ill offenders who have been convicted of a crime. The Mental Health Act 2001, the Mental Health Commission, and its Mental Health Tribunals are for those who have been involuntarily detained through an Admission Order issued by doctors at an approved Mental Health Centre. Patients at Central Mental Hospital are largely the former, but there are a significant number of the latter detained at Central Mental Hospital as provides the only “high-secure” and “medium-secure” facilities in Ireland. Non criminal mentally ill may be transferred to Central Mental Hospital by the decision of a Tribunal.

Despite provisions of the Mental Health Act 2001 (and its 2008 amendments) to the contrary, psychiatry in Ireland continues to be practiced as it was under the old 1945 law.

Under the new Act, the decision regarding involuntary detention of a patient is meant to be the sole responsibility of the Responsible “Consultant” Psychiatrist caring for the patient and an independent Consultant Psychiatrist, with a Tribunal reviewing their determinations.

However, despite the clear intent of the new Act, the Responsible “Consultant” Psychiatrist will not make a decision, but defer to the judgement of forensics (e.g. Dr Damian Mohan and Dr Harry Kennedy) in any case where there is a perceived risk associated with release. There is absolutely no role for the forensics in the new Act. Never-the-less the forensics feel free to write opinions (often based on mistaken interpretations and lack of historical context) directly into patients clinical files.

Once written into the patient’s record, there is no means to challenge or correct these “facts,” and no Responsible “Consultant” Psychiatrist will dare challenge them. Even if these records are challenged at a tribunal, there is little likelihood that the Tribunal will perform the investigation to evaluate these challenges.

In many cases, these “Consultants” are not actual Consultants as defined by the Act: frequently these are locum trainees – often young doctors without a specialty in psychiatry working in Ireland on temporarily visas. This is due to chronic shortage of Specialists in Psychiatry or doctors who have in the past worked as Consultants for the regional Health Boards. These locums are reluctant to do other than what their employer asks them. Their alternative is to return home. Only specialists in psychiatry (or child psychiatry) and those who previously were Consultants for one of the subsumed regional Health Boards are Consultant Psychiatrists under the Act. No one else is a “Consultant” and these locums *under law* have no authority to detain people or force treament on them.

The Mental Health Commission’s guide to the new Act makes it appear very different from this, but in practice there is no right of the patient to face their accuser at a Tribunal or obtain evidence through discovery.

Due to budgetary constraints Tribunals generally sit on the very last day (day 21) following the issuance of a detention renewal order. Because of this they render a decision on that same day. Adjournment to allow a Tribunal to consider the evidence carefully is very rare. There is therefore no opportunity for a patient’s solicitor to request to cross examine the independent Consultant Psychiatrist or to subpoena witnesses and evidence (other than that which may be present at the hospital where the Tribunal takes place).

It looks, then, as if the Commission and the Tribunals have merely added further inertia to the system viewed from the point of view of the patient? Maybe the politicians will revisit the whole area again? What were they trying to achieve in 2001 and 2008 anyway? Surely there is some way to make the system more humane and responsive without recourse to legislation at all? I am always at a loss to know why so many well-qualified, well-paid, well-motivated people working in the area of mental health seem to have very little insight into the patient's personal position not only in their scheme of things but in society in general. The abuse has gone on far too long.

I think I'll chance a tentative diagnosis of chronic career-fixation neurotic-paralysis.
Its seems to be systemic, malignant, and metastatic.
Its a lousy acronym, but its about as succinct as I can manage at this stage of examination. I suspect a drastic political remedy will have to be prescribed. I'm not sure if we have the ingredients in the country.

Straitjackets for all so called psychiatrists who behave like Moaner Mohan , how dare the
likes of them hold court over anybodys brain . typical , the lunatics are running the asylums
of that let there be no doubt ,

That guy who legged it to Great Britain many moons ago caught the whole shaggin lot of
them on the hop , he was a patient in Dundrum but could go out and about when the
humour took him , he managed to join a bikers club ( when commited ) and as long as he
was 'home' before lights out he was ok , then he took advantage of his perks , scooted to
G.B. , was assessed by G.B. psychiatrists and was found to be quite sane so was free to
remain , i believe he is 'getting on with his life' today much to the disgust & embarrasment
of his doc-shocks in Ireland .

'Go boil thine heads' would be a great title should he ever write a book .

Clinical Director of Central Mental Hospital Professor Harry Kennedy was hired by a Christian Brothers School to give an expert assessment of a teacher who claimed he was bullied by his headmistress.. Prof Kennedy got the dates wrong by several years when he tried to blame a teacher's later extra-marital affair on the teacher's depression. Dr Kennedy was supporting the school administration's view, to counter the teacher's argument that the depression was in fact due to an earlier workplace incident:

The teacher "had refused to accept the “grossly defiant and extremely abusive” pupil back despite pressure from" the principal, who "was then vice-principal but who became principal a short time later. After having been forced to take the pupil back into class an issue had arisen over timetabling and that he would have to teach other subjects for which he had not been trained."

The Irish Times Weekend Review has an interesting article by Jason Walsh on page 6.
It gets to the systemic roots of the issue(rather than individual cases) and the medicalisation of often socially caused behaviour.
Interesting account of a US follower of RD Laing who set up the established psychiatric circus and blew them wide open, not once but twice, exposing the preconcieved self-serving nature of professional diagnoses.Worth a read. Includes a mention of Big Pharma's predatory role in the process.

Forensic psychiatrists in particular have the most power; they can put anyone away and there is nothing anyone else can do about it. Being in the public employ, they should be made accountable for their private consulting, for example, to the Catholic church.

See below article where a young 26 year old woman has been detained for five years because she might be promiscuous:

Deputy Seanad Dan Boyle (Green): "The woman had been there for five years and one of the reasons for her continued detention – “and I will define it as detention” – was that she was defined medically by some person as being in danger of being promiscuous if she was to get her liberty."

Bejesus, who made this call - the Catholic Taliban? Is promiscuity a crime or a harm in Ireland?

Hi Petra. In Donegal to play golf tomorrow and Friday in Murvagh. Will probably be having an eary night. Worried more now about how the balls will be flying tomorrow and the next day. Anyway tnx for info.

i think that true infantalism should not be ignored by the mental health.

a raport written by Kathi Stringer clearly stateds that this is not a fetish. and that there is no known cure. as a sufferer mental health wont recognize this condition and it left me taking a few overdosis.